The Role of Osteopontin as a Diagnostic and Prognostic Biomarker in Sepsis and Septic Shock.

Luigi Mario Castello,Vincenzo Cantaluppi,Paolo Navalesi,Greta Zunino,Luca Molinari,Francesco Gavelli,Marco Quaglia,Mattia Bellan,Livia Salmi,Rosanna Vaschetto,Annalisa Chiocchetti,Gian Carlo Avanzi,Marco Baldrighi

doi:10.3390/cells8020174

Abstract

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host-response to infections. Osteopontin (OPN) is an extracellular matrix protein involved in the inflammatory response. Our aim was to evaluate the diagnostic and prognostic performance in sepsis of a single OPN determination in the Emergency Department (ED). We conducted a single-centre prospective observational study in an Italian ED where we enrolled 102 consecutive patients presenting with suspected infection and qSOFA ≥ 2. OPN plasma concentration was found to be an independent predictor of sepsis (OR = 1.020, 95% CI 1.002–1.039, p = 0.031) and the diagnostic receiver operating characteristic (ROC) curve resulted in an area under the curve (AUC) of 0.878. OPN levels were positively correlated to plasma creatinine (r = 0.401 with p = 0.0001), but this relation was not explained by the development of acute kidney injury (AKI), since no difference was found in OPN concentration between AKI and non-AKI patients. The analysis of 30-days mortality showed no significant difference in OPN levels between alive and dead patients (p = 0.482). In conclusion, a single determination of OPN concentration helped to identify patients with sepsis in the ED, but it was not able to predict poor prognosis in our cohort of patients.

Highlights

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host-response to infection, affecting about 13 million people every year worldwide, with mortality rates higher than 30% according to some reports [1].Septic shock, on the other hand, identifies a subset of patients in which sepsis is associated with both persisting hypotension that requires vasopressors to maintain a mean arterial pressure ≥65 mmHg and a serum lactate level >2 mmol/L, despite adequate volume resuscitation [1]
From October 2016 to March 2018, 102 consecutive patients with suspected sepsis were enrolled in this study
The same analysis was performed considering 7-days mortality, but once again OPN showed a poor prognostic performance and was not identified as an independent predictor of worse outcome. In this pilot study, performed on a cohort of 101 patients admitted to the Emergency Department (ED) over an 18-month period, we show that the baseline value of plasmatic OPN is a promising diagnostic biomarker for the early diagnosis of sepsis

Summary

Introduction

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host-response to infection, affecting about 13 million people every year worldwide, with mortality rates higher than 30% according to some reports [1].Septic shock, on the other hand, identifies a subset of patients in which sepsis is associated with both persisting hypotension that requires vasopressors to maintain a mean arterial pressure ≥65 mmHg and a serum lactate level >2 mmol/L, despite adequate volume resuscitation [1]. Sepsis and septic shock are time-dependent conditions in which a delay in antibiotic administration is associated with a significant increase in mortality rates, whereas prompt recognition and early treatment initiation are known to improve the patient’s outcome [3]. For these reasons, in the Emergency Department (ED) the SOFA score appears to have great limits of application, mostly related to the amount of time required to be completed, whilst the use of the quick-SOFA score (qSOFA) has been recommended for a rapid identification of septic patients [1].

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